War Zone Veterans Research Articles

Military and Veteran Families and Children: Policies and Programs for Health Maintenance and Positive Development and commentaries

Military and Veteran Families and Children: Policies and Programs for Health Maintenance and Positive Development and commentaries

Contributors to Hypervigilance in a Military and Civilian Sample

Hypervigilance toward ambiguous or threatening stimuli is a prominent feature in many trauma survivors including active and returning soldiers. This study set out to investigate the factors that contribute to hypervigilance in a mixed sample. One hundred forty-five individuals, 50 of whom were war zone veterans, filled out a series of questionnaires including the Hypervigilance Questionnaire (HVQ; Kimble, Fleming, & Bennion, 2009). Other participants included military cadets, college undergraduates, and a traumatized community sample. In this sample, a history of military deployment and posttraumatic stress disorder symptoms independently predicted hypervigilance. The findings suggest that deployment to a war zone, in and of itself, can lead to hypervigilant behavior. Therefore, characterizing hypervigilance as pathological in a veteran sample must be done so with caution.

Mild Traumatic Brain Injury and Posttraumatic Stress Disorder: Clinical and Conceptual Complexities

The wars in Iraq and Afghanistan have raised public con-sciousness of traumatic brain injury (TBI) and posttraumaticstress disorder (PTSD), two of the most common healthconsequences of contemporary military deployment. TBI andPTSD may each in their own right exert a toll on affectedindividuals. Within the war zone, however, brain injury oftenoccurs within a broader context of extreme psychologicalstress (i.e., traumatic stress). Th e same dangerous circumstances(e.g., combat, encounters with improvised explosive devices)that lead to increased risk of TBI also place service membersat increased risk for PTSD. Therefore, the prevalence ofPTSD in returning war-zone veterans who have a history ofdeployment-related TBI are elevated, especially when thebrain injury falls at the milder end of the severity range,as is the case with the majority of deployment-relatedTBIs. For example, a RAND study estimated that almost20% of a representative sample of Operation EnduringFreedom/Operation Iraqi Freedom veterans screened positivefor history of mild TBI (mTBI), and that of those reportinga deployment mTBI, approximately 34% also screenedpositive for PTSD (Tanielian & Jaycox, 2008).The comorbidity of mTBI and PTSD is not limited, however,to war-zone veterans. Civilian events such as motor vehicleaccidents and interpersonal ass ault may also be associated withboth TBI and psychological traum a sufficiently severe to lead toPTSD. The prevalence of comorbid mTBI and PTSD is notwell-documented in civilians, but mTBI and/or PTSD eachaffect many civilians. The Centers for Disease Control andPrevention (2010) estimate that over 1.7 million people sustaina TBI each year, and that over 75% of these injuries are mild.A U.S. population-based survey estimated the prevalenceof PTSD in the general population to be at 7–8% (Kessler,Sonnega, Bromet, Hughes, & Nelson, 1995).Despite the relatively high rates of mTBI and PTSD inat-risk populations, much remains unknown about the clinicalconsequences in individuals who have both incurred anmTBI and experience PTSD. The sequelae of mTBI are oftenreferred to as post traumatic or post concussive symptoms.Some post traumatic symptoms (e.g., irritability, neurocog-nitive complaints) overlap with PTSD symptoms, makingdifferential diagnosis difficult. Other conditions commonlyco-occurring with TBI history and PTSD, such as chronicpain, depression, and substance abuse, may further complicatethe clinical presentation of patients with both history of mTBIand PTSD. As a result, considerablechallengesarise inregardsto both the assessment and clinical management of patientswith co-morbid mTBI and PTSD.The field of neuropsychology is well-positioned to tacklemany of the clinical and conceptual challenges posed bycomorbid mTBI and PTSD. This virtual special issue of theJournal of the International Neuropsychological Society (JINS)compiles eight papers on the topic of TBI and/or PTSD thatwere previously published in regular issues of JINS. The papersare for the first time grouped together with the goal of collec-tively addressing the issues con fronting clinicians who assessand care for patients with history of mTBI and PTSD.

MH Care Won't Harm Careers in Foreign Service, Clinton Says

MH Care Won't Harm Careers in Foreign Service, Clinton Says

War Zone Veterans Returning to Treatment

Patients with mental illness often return for further treatment after an initial episode of care. Two processes that may contribute to the return for further treatment are the severity of patients' initial social and clinical status; and/or deterioration in their status over time, regardless of their initial status. This study examined these processes in an administrative database of war zone veterans who had received outpatient treatment from a Veterans Affairs specialized posttraumatic stress disorder program. The results suggest that both initial severity and deterioration of status contribute to return to treatment and involve changes in both social functioning and psychopathology. Determination of the direction of effects between social functioning and psychopathology showed that psychopathology in the form of PTSD, other Axis I disorder or violent behavior generally affected subsequent social functioning, but not vice versa. Psychopathology in the form of alcohol or drug abuse/dependence, however, showed reciprocal effects with social functioning. These results point to the importance of emphasizing interventions that address social dysfunction and that address psychopathology, from the beginning of treatment as a way of maximizing the benefits and minimizing the need for recurrent care.

Female Veterans of Iraq and Afghanistan Seeking Care from VA Specialized PTSD Programs: Comparison with Male Veterans and Female War Zone Veterans of Previous Eras

Differences in the characteristics and mental health needs of female veterans of the Iraq/Afghanistan war compared with those of veterans of other wars may have useful implications for VA program and treatment planning. Female veterans reporting service in the Iraq/Afghanistan war were compared with women reporting service in the Persian Gulf and Vietnam wars and to men reporting service in the Iraq/Afghanistan war. Subjects were drawn from VA administrative data on veterans who sought outpatient treatment from specialized posttraumatic stress disorder (PTSD) treatment programs. A series of analyses of covariance (ANCOVA) was used to control for program site and age. In general, Iraq/Afghanistan and Persian Gulf women had less severe psychopathology and more social supports than did Vietnam women. In turn, Iraq/Afghanistan women had less severe psychopathology than Persian Gulf women and were exposed to less sexual and noncombat nonsexual trauma than their Persian Gulf counterparts. Notable differences were also found between female and male veterans of the Iraq/Afghanistan war. Women had fewer interpersonal and economic supports, had greater exposure to different types of trauma, and had different levels of diverse types of pathology than their male counterparts. There appear to be sufficient differences within women reporting service in different war eras and between women and men receiving treatment in VA specialized treatment programs for PTSD that consideration should be given to program planning and design efforts that address these differences in every program treating female veterans reporting war zone service.

Partnering in Support of War Zone Veterans and Their Families

CME Educational Objectives 1. Identify readjustment issues for war zone veterans and their families related to the deployment cycle. 2. Provide a rationale for Veterans Affairs/Department of Defense/State and Community Partnerships in support of returning war zone veterans and their families. 3. Identify potential partners and actions in providing support and mental health services for returning war zone veterans and their families.

This Issue: Meeting the Emotional Needs of Returning War Zone Veterans

<p>This series of articles in Psychiatric Annals focuses on the psychological effects of combat operations on military service personnel, on their families, and on the communities that they leave and re-enter post-deployment. This series also focuses on individuals who have and have not developed varying levels of emotional distress with varying levels of psychological dysfunction who are predominantly classified with the singular diagnosis of posttraumatic stress disorder (PTSD).</p> <h4>ABOUT THE GUEST EDITOR</h4> <p>Harold M. Ginzburg, MD, JD, MPH, resides and maintains a private practice in general and forensic psychiatry in Metairie, Louisiana, a suburb of New Orleans. His private practice primarily involves evaluating and treating patients who have developed psychiatric or neuropsychiatric problems as a result of physical injury, chronic illness, or traumatic incidents.</p> <p>Dr. Ginzburg was a Navy Submarine and Diving Medical Officer before joining the U.S. Public Health Service as a Commissioned Officer. He retired after more than 20 years of service with the Navy-rank equivalent of Captain after serving with the National Institute of Drug Abuse, the National Institute of Allergy and Infectious Diseases, and the Office of Emergency Preparedness, Office of the Assistant Secretary of Health, U.S. Public Health Service.</p> <p>He is a Diplomate of the American Board of Psychiatry and Neurology (Psychiatry) and is a Distinguished Life Fellow of the American Psychiatric Association, a Fellow of the American College of Preventive Medicine, and was a Fellow of the Infectious Disease Society of America. He is currently a Clinical Professor, Department of Psychiatry and Neurology, Tulane University Medical Center, a Clinical Professor, Department of Psychiatry, Louisiana State University Health Sciences Center, and also an Adjunct Professor of Psychiatry, Uniformed Services University of the Health Sciences, School of Medicine, Bethesda, Maryland. He is a member of the Maryland Bar.</p> <p>Dr. Ginzburg has published more than 150 articles in medical and legal journals.</p>

Male war-zone veterans' perceived relationships with their children: the importance of emotional numbing.

Despite growing recognition of substantial interpersonal impairment among many war-zone veterans with posttraumatic stress disorder (PTSD), little is known about the association between PTSD symptomatology and veterans' relationships with their children. This study examined the differential pattern of associations between the symptom clusters of PTSD and the perceived father-child relationships of 66 male Vietnam veterans. Analyses revealed that only the emotional numbing cluster was significantly related to perceived quality of all relationship domains. The association between emotional numbing and perceived relationship quality remained significant in regression analyses even after controlling for fathers' family-of-origin stressors, combat exposure, depression, and substance abuse. Findings suggest that emotional numbing may be the component of PTSD most closely linked to interpersonal impairment in war-zone veterans.

The development of a scale to assess war-time atrocities: the War Events Scale.

The War Events Scale (WES) was developed to assist clinicians with the assessment of war zone veterans' exposure to, and participation in war-time atrocities distinct from combat, and their current distress from these events. Data concerning content validity, test-retest reliability, internal consistency, as well as correlational data with the Combat Exposure Scale and the Mississippi Scale are presented. Results indicate that the WES does have adequate internal consistency and test-retest reliability, and correlates moderately with the Combat Exposure and Mississippi Scales. Initial results suggest that the WES may be helpful in collecting extremely sensitive information concerning the exposure of war zone veterans to atrocities.

Assessment of Intellectual Resources in Gulf War Veterans: Relationship to PTSD

War stress frequently leads to the subsequent development of psychopathology including posttraumatic stress disorder (PTSD), but recent research has indicated that individual difference factors may alter vulnerability to trauma-related distress. In an effort to examine the potential buffering effects of intellectual resources on PTSD development, this study assessed intellectual functioning in subsets of Persian Gulf War zone veterans with and without PTSD diagnoses. The two subsets, comprised of 18 PTSD-diagnosed and 23 psychopathology-free Persian Gulf War veterans, were compared on a multi-faceted test of intellectual functioning, the Wechsler Adult Intelligence Scale-Revised. As compared to psychopathology-free veterans, PTSD-diagnosed veterans performed significantly more poorly on tasks of verbal intellectual functioning including those tasks thought to reflect premorbid functioning. The two groups did not differ on visuospatial tasks or on a task of attention. Findings suggest that intellectual resources, particularly verbal skills, may buffer development of stress-related psychopathology following trauma exposure.

A short form of the Mississippi Scale for measuring change in combat-related PTSD.

In large-scale surveys or program evaluations, investigators most often wish to assess multiple domains of functioning, while at the same time minimizing the overall length of the data collection protocols. In addition, studies of treatment interventions require instruments which offer the greatest opportunity of detecting change in the variables of interest. Toward these ends, we present an 11-item version of the Mississippi Scale for Combat-Related PTSD. The sample was composed of 436 war zone veterans who received specialized outpatient treatment for PTSD, and who were followed up in 4-month intervals for 1 year. Items were identified for inclusion in a short scale on half of the sample. The scale was then cross-validated on the other half. This short form of the Mississippi Scale has good internal consistency, good correspondence with the full scale, significant sensitivity to change in symptom severity, and significant relationships between change and clinicians' ratings of improvement after 1 year, number of treatment sessions received and number of months in treatment.

A short form of the Mississippi Scale for measuring change in Combat‐Related PTSD

AbstractIn large‐scale surveys or program evaluations, investigators most often wish to assess multiple domains of functioning, while at the same time minimizing the overall length of the data collection protocols. In addition, studies of treatment interventions require instruments which offer the greatest opportunity of detecting change in the variables of interest. Toward these ends, we present an 11‐item version of the Mississippi Scale for Combat‐Related PTSD. The sample was composed of 436 war zone veterans who received specialized outpatient treatment for PTSD, and who were followed up in 4‐month intervals for 1 year. Items were identified for inclusion in a short scale on half of the sample. The scale was then cross‐validated on the other half. This short form of the Mississippi Scale has good internal consistency, good correspondence with the full scale, significant sensitivity to change in symptom severity, and significant relationships between change and clinicians' ratings of improvement after 1 year, number of treatment sessions received and number of months in treatment.